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Dr. David
Dr. David, Board Certified Physician
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I am a 47 yo male in great general and heart health. Top 2%

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I am a 47 yo male in great general and heart health. Top 2% in fitness (as measured on recent treadmill stress echo) due to daily cardio exercise. Blood lipids and organ enzymes are great: LDL 130, HDL 101, Triglycerides 59, VLDL 12, AST 17, ALT 21, Fasting Glucose 91, Alkaline Phosphatase 79, BMI=24.2, BUN 15, 12% Body Fat, etc, all other standard blood metrics are fully within normal limits. I have never smoked. I am non-hypertensive and take no medications other than a daily multivitamin.
My only vice is consuming a bottle of red wine most nights of the week (4-5). I've been doing this for 10+ years with that level of ETOH being a pretty steady state. Liver enzymes never show any apparent elevation. I do come from a family of alcoholics, but none of those alcoholics ever had any known liver-related problems (LOL, they all died of lung-cancer - smoking-related illness). I don't want to turn this into a debate about whether I am an alcoholic. My simple question is: How dangerous is this level of ETOH consumption to my health? From the research I've done, it seems there is much individual difference with regard to a body's tolerance and adaptability to alcohol consumption. Some people seem to tolerate even more than this amount with no apparent ill-effects. Others seem to be much more susceptible to liver/organ damage. Assuming, based on family history, I have some amount of natural genetic protection against high ETOH consumption and am not particularly vulnerable to liver damage, is it possible I can continue to consume this amount of ETOH without ill-effects or I am unequivocally destined to an eventual bad health result?
Hello, this is Dr. David. I have read your question and I'm ready to help.

most epidemiological studies suggest that more than 1-2 glasses of wine per night does not add any additional benefit to cardiovascular health and when you get up to a bottle of wine which is about 4-8 glasses depending on the pour amout, you see negative affects on overall health.

normal liver enzyme leves will often now show inflammation from this much alcohol, but if you draw a GGTP level, I bet yours would be elevated.

you can do more intervention to see how much liver damaged you have had. a liver MRI scan and liver biopsy can see how much of your liver has changed into fat and cirrhosis. I suspect that a portion of your liver has already turned cirrhotic.

no one is ever destined to evental bad health results. tomorrow is another day. I am glad you are exercising so well. you also want to add extra good fats and fish and olive oils and whole grains and nuts into your diet to hopefully get your LDL levels down below 100.

perhaps more liver testing and GGTP levels and a liver biopsy showing you cirrhosis changes in your liver will help encourage you to drink less wine per might. even cutting down to 1/2 a bottle would help in the long run. and avoiding things like excessive tylenol use can help your liver as well.

are you willing to get these additional tests on your liver to show you more about how yoru liver is doing at this point?
Customer: replied 3 years ago.

Thanks for the quick reply, Dr.David. So if I understand the tone and context of your reply, essentially you're stating that the amount of alcohol I am currently consuming is in all likelihood damaging my health, although the effects may have been, or may even currently be, at a subclinical level. However, it also appears that you believe that if I continue this pattern, that I likely would soon develop and present with clinical symptoms/evidence of a fatty or partially cirrhotic liver.

If so, rather than move forward with testing, it sounds like it would be best if I just immediately reduced my ETOH consumption. If the liver is just fatty, it can recover, If it's already cirrhotic, I still may be OK if I curtail the drinking damage immediately, as it's my understanding that the liver can function fairly well even if minimally cirrhotic, although that probably somewhat increases the possibility of eventual liver cancer.

Am I correct in my understanding?

most likely damaging your liver, and if you do more sophisticated blood and liver imaging testing, you and your doctors will be able to see it.

no one can say when you will develop symptoms from cirrhosis. most likely a portion of your liver has already turned cirrhotic already. how much can be determined by liver ultrasound or liver MRI scan and liver biopsies.

it would be best for you to slowly cut down on your liver consumption slowly, like taking down a 1/4 of a bottle a week or so

fatty liver is cirrhotic liver or cirrhosis change is the same as fatty change in the liver. both are the same thing and are a permanant change of your normal liver cells turning into fat which will not turn back to normal liver cells.

you still can live with 1/2 or even 1/4 of your liver, but you don't want to do this.

if you start cutting down your alcohol use, you can stop further parts of your liver from turning into cirrhosis or turning into fat cells. but the parts of the liver which are already turned will not reverse.
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